Latent TB Infection Testing and Treatment: 

Summary of U.S. Recommendations

Eliminating tuberculosis 

(TB) in the United States 

requires expanding 

testing and treatment 

of latent TB infection.

The Centers for Disease Control and Prevention (CDC)

and the U.S. Preventive Services Task Force (USPSTF)

recommend testing people that are at increased risk 

for TB infection. Clinicians, health care agencies, and 

community organizations, especially those serving 

populations at risk, have a critical role in TB elimination. 

JUNE 2020 www.cdc.gov/tb 1
WHO SHOULD BE TESTED 

FOR TB INFECTION?

CDC and the USPSTF recommend testing populations that 

are at increased risk for TB infection.

•Anyone can get TB. However, some people 

have a higher risk of getting infected with 

TB bacteria. CDC supports the USPSTF 

recommendation to test certain groups at 

risk for TB infection. These groups include:

• People who were born in or who 

frequently travel to countries where TB 

disease is common, including Mexico, the 

Philippines, Vietnam, India, China, Haiti, 

Guatemala, or other countries with high 

rates of TB. (In general, people born in 

Canada, Australia, New Zealand, western 

European countries, or northern European 

countries are not considered at high risk 

for TB infection unless they spent time in a 

country with a high rate of TB.)

• People who currently live or used to live 

in large group settings where TB is more 

common, such as homeless shelters, 

prisons, or jails.

•CDC also recommends testing for TB 

infection for other groups at risk. These 

groups include:

• Health care workers and others who 

work in places with high risk for TB 

transmission, such as hospitals, homeless 

shelters, correctional facilities, nursing 

homes, and residential homes for those 

with HIV.

• Anyone who has spent time with a person 

who has infectious TB disease.

•Children, especially those under age 5, 

have a higher risk of developing TB disease 

once infected. Therefore, testing for TB 

infection in children is important if they are 

in one of the risk groups noted to the right.

•Some people 

with weaker 

immune systems, 

such as those with 

certain health conditions or 

who take certain medications, have a 

higher risk of developing TB disease once 

infected. Testing for TB infection should 

be part of their regular medical care. 

Health conditions that increase a person’s 

risk of developing TB disease once 

infected include:

• HIV infection

• Recent 

infection with 

M. tuberculosis

(within the last 

two years)

• History of 

untreated or 

inadequately 

treated 

TB disease

• Medical 

treatments that 

suppress the 

immune system 

(such as tumor 

necrosis factoralpha [TNF] 

antagonists, 

corticosteroids, 

or drug therapy 

following organ 

transplants)

• Silicosis; chronic 

renal failure; 

leukemia; or 

cancer of the 

head, neck, 

or lung

• Diabetes mellitus

• A gastrectomy or 

jejunoileal bypass

• Low body weight 

(<90% of ideal 

body weight)

• Substance use 

(such as injection 

drug use)

2
RECOMMENDED 

TESTS FOR TB

INFECTION:

Testing for TB infection should be a 

routine and integral part of health care 

for patients with increased risk for TB. 

Health care providers are encouraged to 

use newer TB blood tests to screen 

for TB infection.

•There are two kinds of tests that are 

used to determine if a person has been 

infected with TB bacteria: the TB blood 

test and the TB skin test.

TB Blood Tests (Interferon Gamma 

Release Assays [IGRAs]) 

TB blood tests (sometimes called IGRAs) use 

a blood sample to find TB infection. The tests 

measure the response of TB proteins when they 

are mixed with a small amount of blood. Only 

one visit is required to draw blood for the test.

TB blood tests are the preferred method of TB 

testing for people 5 years of age and older who 

have received the bacille Calmette-Guérin 

(BCG) vaccine.

TB Skin Test (TST) 

The TB skin test is also called the Mantoux 

tuberculin skin test (TST). With a TB skin test, 

a health care provider injects a small amount 

of testing fluid (called tuberculin or PPD) into 

the skin on the lower part of the arm.

After 2-3 days, the skin test reaction must be 

examined by a trained health care worker. 

The health care worker measures any 

swelling where the tuberculin was injected to 

determine if the reaction to the test is 

positive or negative.

TB skin tests are an acceptable alternative 

in situations where a TB blood test is not 

available, is too costly, or is too burdensome.

•A positive reaction to a TB blood test 

(IGRA) or TB skin test (TST) usually 

means TB infection. More tests, such 

as a chest x-ray, are needed to rule 

out TB disease.

•A diagnosis of latent TB infection is 

made if a person has a positive TB 

blood test (IGRA) or TST result and 

a medical exam does not indicate 

TB disease.

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RECOMMENDED 

TREATMENT 

REGIMENS 

FOR LATENT 

TB INFECTION:

•Treating latent TB infection is effective in preventing 

TB disease and less costly than treating TB disease.

•There are several treatment regimens for the 

treatment of latent TB infection.

• These regimens use the drugs isoniazid,

rifapentine, or rifampin.

•CDC and the National Tuberculosis Controllers 

Association (NTCA) preferentially recommend shortcourse, rifamycin-based, 3- or 4-month latent TB 

infection treatment regimens over 6- or 9-month 

isoniazid monotherapy (6H or 9H, respectively).

• Short-course regimens include:

• Three months of once-weekly isoniazid plus 

rifapentine (3HP)

• Four months of daily rifampin (4R)

• Three months of daily isoniazid plus 

rifampin (3HR)

• Short-course latent TB infection treatments are 

effective, are safe, and have higher completion 

rates than longer treatments. 

• If a short-course treatment regimen is not an 

option, 6H or 9H is an effective alternative latent 

TB infection treatment regimen.

Shorter regimens help 

patients finish treatment.

•All treatment must be modified if the patient is 

a contact of an individual with drug-resistant TB 

disease. Consultation with a TB expert is advised 

if the known source of TB infection has 

drug-resistant TB. 

•Clinicians should choose the appropriate treatment 

regimen based on drug susceptibility results of 

the presumed source case (if known), coexisting 

medical conditions (e.g., HIV infection), and 

potential for drug- drug interactions.

•Clinicians may choose to administer latent TB 

infection treatment through directly observed 

therapy (DOT) or self-administered therapy 

(SAT) based on local practice, individual patient 

attributes, and provider preferences.

LATENT TB 

INFECTION 

ONLINE

RESOURCE 

HUB

CDC’s One-stop Shop for 

Information, Guidance, 

and Education

The Latent TB Infection Online Resource Hub is a 

collection of downloadable materials for informing 

and educating the public, health care providers, 

policy makers, and other partners about the 

importance of expanded latent TB infection testing 

and treatment. Available resources include:

• Guidance Documents

• Fact Sheets for Clinicians 

& Patients

• Communication Templates

• Key Messages & Social 

Media Content

• Slide Sets

• Images & Videos

• Infographics

• Helpful Links & More

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